MEDICARE: GLENN HARRIS SEGAL P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	017632-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GS0Q4W1E1	OTHER	NY	MEDICARE PIN#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376529107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN HARRIS SEGAL P.T.

Provider Business Mailing Address
First Line	:	152 ISLIP AVE
Second Line	:	STE.15
City	:	ISLIP
State	:	NY
Zip	:	11751-3225
Country	:	US
Telephone Number	:	631-277-6767
Fax Number	:	631-277-4311

Provider Business Practice Location Address
First Line	:	152 ISLIP AVE
Second Line	:	STE.15
City	:	ISLIP
State	:	NY
Zip	:	11751-3225
Country	:	US
Telephone Number	:	631-277-6767
Fax Number	:	631-277-4311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/09/2007

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